The clinical characteristics and surgical prognosis of pediatric trapdoor fracture of orbital floor fractures

Abstract

Objective To investigate the clinical features and surgical prognosis of pediatric trapdoor fracture of orbital floor fractures. Methods A retrospective analysis. The clinical data of 45 patients with trapdoor fracture involving orbital floor were collected, aging 3-18 years old. Each patient was followed-up for 6-9 months after orbital surgery. Results Forty-five (41.3%) cases had trapdoor fracture involving orbital floor in all 109 children with orbital fractures. Diplopia was noted in 97.8% patients, ocular-heart reflex including nausea and vomiting in 51.1% patients, extra-ocular muscle limitation in all the patients. There were significant differences in the constituent ratios of ocular alignment in the primary position in different scales of ocular motilities (χ2=11.18, P=0.025). Forty-three (95.6%) cases had soft tissue entrapment confirmed by CT scan. In the final visiting, 21 cases obtained full ocular motilities and no diplopia; 17 cases had residual diplopia only in peripheral visual field; 7 cases remained diplopia in the primary and reading position though ocular movements had been improved a lot. Compared with the groups of patients who underwent surgeries during 6- 14 days after injuries and 14 days and more after initial injuries, the patients who underwent prompt orbital surgeries within 5 days after trauma appeared to get better ocular movement and binocular single vision (χ2=7.08, P=0.029; χ2=7.55, P=0.023). Conclusions Trapdoor fracture involves the floor orbit, frequently occurs in children. The most important characteristics include symptomatic diplopia with restrictive ocular movement, ocular-heart reflex and soft tissue entrapment confirmed by CT scan. The patients who undergo prompt surgeries have better ocular movement and binocular single vision. Key words: Orbital fracture; Trapdoor fracture; Ocular-heart reflex; Ocular movement; Surgery